Timing and strategies for early management and rehabilitation of acute ischemic stroke

ZHAN Qing; WANG Lijing

doi:10.12022/jnnr.2016-0014

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Journal of Neurology and Neurorehabilitation ›› 2016, Vol. 12 ›› Issue (1) : 1-7. DOI: 10.12022/jnnr.2016-0014

Editorial

Timing and strategies for early management and rehabilitation of acute ischemic stroke

ZHAN Qing^1,2, WANG Lijing^1,2

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Abstract

Rehabilitation of stroke is an indispensable process in the management of stroke; however, there is no consensus on timing and the specific strategies for early rehabilitation intervention. During 1994-2013, American Heart Association/American Stroke Association (AHA/ASA) successively released six versions of guideline for the early management of patients with acute ischemic stroke. The recommendation on early rehabilitation intervention was first proposed in the guideline of 2003, recommending that the patients with acute ischemic stroke should be managed in comprehensive specialized stroke care units which incorporates rehabilitation personnels. Moreover, the prevention of subacute complications through early rehabilitation intervention was emphasized, and the passive and full-range-of-motion exercises for paralyzed limbs can be started during the first 24 hours, while avoiding falls. The enteral nutrition through nasogastric gavage and the use of percutaneous endoscopic gastrostomy (PEG) to sustain nutrition in patients with swallowing dysfunction were also primarily mentioned in the guideline. In the guideline of 2007, assessment of swallowing before starting eating or drinking was recommended, and the patients who cannot take food and fluids orally should receive nasogastric gavage or PEG. Early mobilization for less severely affected patients and measures to prevent subacute complications of stroke in specialized stroke care units were recommended in the guideline of 2013, and the assessment of swallowing and the appropriate choice to sustain nutrition were stressed on again. However, the final results of a very early rehabilitation trial (AVERT), which was a randomised controlled trial to evaluate the efficacy and safety of very early mobilization within 24 h of stroke onset, could not give a definite conclusion on the benefits in very early rehabilitation for patients with acute ischemic stroke. No similar large-sample clinical trials have been done in China. Therefore, there is no consensus on the optimal timing of rehabilitation intervention for ischemic stroke, and how soon should it begin is still unknown. In principle, the timing of rehabilitation should be based on the premise that not to aggravate the underlying conditions, and the early rehabilitation for acute ischemic stroke is recommended to implement in specialized stroke units.

Key words

Acute ischemic stroke / Early management / Rehabilitation / Guideline

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ZHAN Qing, WANG Lijing. Timing and strategies for early management and rehabilitation of acute ischemic stroke[J]. Journal of Neurology and Neurorehabilitation. 2016, 12(1): 1-7 https://doi.org/10.12022/jnnr.2016-0014

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Funding

Foundation of Shanghai Disabled Persons’ Federation (No. K2014015); Shanghai Three-year Action Planning for Further Accelerating Development of Chinese Medicine (No. ZY3-FWMS-2-1012); Construction Project of Specialty of Traditional Chinese Medicine in Pudong New Area of Shanghai (No. PDZYXK-1-2014001)